Crohn's disease-related stoma complications and their impact on postsurgical course

Introduction: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. The diversion through a colostomy or an ileostomy is sometimes required for disease control. In these patients, common stoma-related complications sum up with CD-related complications and often require revisional surgery. Methods: The aim of the study was to assess stoma morbidity after surgery for CD and to identify the burden of CD-related complications. Details of past medical history, surgery and follow up of 54 consecutive patients operated on for CD with any sort of stoma were retrieved from the stoma therapist prospectively maintained database. Results: In our series, 23 patients had a colostomy, and 31 an ileostomy. CD-related complications arose in 8 patients (including pyoderma gangrenosus in 3 patients, peristomal fistulae in 2, granulomas in 2, and peristomal abscess in 1). Patients with CD-related complications had shorter disease duration (p=0.07) and, more frequently end-stoma (p=0.006). In this cohort, 11 cases had to be surgically treated for peristomal fistulae or abscess, parastomal hernia, prolapse, pyoderma gangrenosus and recurrent CD. Discussion/conclusions: In patients with CD, stoma creation is burdened by a high rate of postoperative complication and a relevant rate is specifically related to CD. Often these patients required to be re-operated on to re-do the stoma. Moreover, end stoma configuration and aggressive CD phenotype are associated to a higher rate of complications